title: [Combination therapy for hypertension].
abstract: The average systolic blood pressure-lowering effect of antihypertensive monotherapy is no more than 9.1 mmHg and for the diastolic value, 5.5 mmHg. Due to the limited effect of monotherapy, 2 or more antihypertensive agents are required in at least two-third of the hypertensive population. Because of their complementary blood pressure-lowering mechanisms and proven efficacy, it is advisable to initiate a combination of a renin-angiotensin-system (RAS) blocking agent with a RAS-independent agent; the choice of initial agents depends on age, ethnicity and co-morbidity. It is preferable that treatment is started using a stepwise approach: 1 agent is started and a second or third agent is added to the regimen. If the patient's actual blood pressure exceeds the target value by more than 20/10 mmHg, an alternative approach would be to start immediately with 2 agents. Compliance to therapy and the continuation of antihypertensive treatment are notoriously poor; treatment using a combination preparation containing 2 or even 3 different components is therefore preferred.
authors.affiliation: Erasmus MC, afd. Inwendige Geneeskunde, Rotterdam.
authors.forename: Anton H
authors.initials: AH
authors.lastname: van den Meiracker
authors.forename: A H J Jan
authors.initials: AH
authors.lastname: Danser
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents